1902096308 NPI number — NEVADA URGENT CARE

Table of content: (NPI 1902096308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902096308 NPI number — NEVADA URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA URGENT CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902096308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEVADA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64772-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-667-9000
Provider Business Mailing Address Fax Number:
417-667-9029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEVADA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64772-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-667-9000
Provider Business Practice Location Address Fax Number:
417-667-9029
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ASBERRY
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
417-667-9000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  089091 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39299015 . This is a "BCBS KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 200517480A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 504034109 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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